Transbuccal versus transoral approach for management of mandibular angle fractures: a prospective, clinical and radiographic study

Abstract

ObjectivesWe compared the transbuccal and transoral approaches in the management of mandibular angle fractures.Materials and MethodsSixty patients with mandibular angle fractures were randomly divided into two equal groups (A, transoral approach; group B, transbuccal approach) who received fracture reduction using a single 2.5 mm 4 holed miniplate with a bar using either of the two approaches. Intraoperatively, the surgical time and the ease of surgical assess for fixation were noted. Patients were followed at 1 week, 3 months, and 6 months postoperatively and evaluated clinically for post-surgical complications like scarring, infection, postoperative occlusal discrepancy, malunion, and non-union. Radiographically, the interpretation of fracture reduction was also performed by studying the fracture gap following reduction using orthopantomogram tracing. The data was tabulated and subjected to statistical analysis. A P-value less than 0.05 was considered significant.ResultsNo significant difference was seen between the two groups for variables like surgical time and ease of fixation. Radiographic interpretation of fracture reduction revealed statistical significance for group B from points B to D as compared to group A. No cases of malunion/non-union were noted. A single case of hypertrophic scar formation was noted in group B at 6 months postsurgery. Infection was noted in 2 patients in group B compared to 6 patients in group A. There was significantly more occlusal discrepancy in group A compared to group B at 1 week postoperatively, but no long standing discrepancy was noted in either group at the 6 months follow-up.ConclusionThe transbuccal approach was superior to the transoral approach with regard to radiographic reduction of the fracture gap, inconspicuous external scarring, and fewer postoperative complications. We preferred the transbuccal approach due to ease of use, minimal requirement for plate bending, and facilitation of plate placement in the neutral mid-point area of the mandible.

Evaluation of management of angle fracture of mandible by using different surgical approaches

“…In our study of 30 cases with mandibular angle fracture mean age was 25.07 years (range, 7-56 years), with male predominance (90%) and road traffic accidents as a most common e ology 18 (60%) and right side predominance 18(60%). The finding of this study is comparable to that by 3 13…”

“…The mean opera ve dura on was lesser in transbuccal approach (111.25 minutes) compared to transbuccal (lower border) approach (120 minutes) and intraoral (122.5 minutes) in case of isolated angle fracture. The mean opera ve me is greater in our study because we took total anesthe c dura on ( me from intuba on to me of 3,8,12,13 extuba on) where as other studies took me from incision to closure. Our study showed greater me for transbuccal (lower border) approach because two miniplates were used for fixa on.…”

Postoperative malocclusion after maxillofacial fracture management: a retrospective case study

“…Owing to the characteristics of the extraoral approach, scarring may occur in the facial area, and the intraoral approach tends to be used as much as possible, but scarring can be reduced sufficiently through accurate incision and suture. Many papers have reported that access to the surgical site is easier, and the reduction of the fracture fragment is more accurate when operating with the extraoral approach [ 7 ].…”

Revisiting the sub-mandibular approach with a modified incision

“…Other modalities like transbuccal trochar system is again an indispensable tool, but greatly challenged by the fact that it severely limits the visualization of the fracture site [ 8 ]. It makes the manipulation of bony fragments difficult and fixation screws and plates are highly difficult to place in the area of interest.…”